AB1582-PARE ASSIGNING A VALUE TO THE ‘PASS’ CONCEPT IN PSORIATIC ARTHRITIS PATIENTS: A SINGLE CENTER DATA.
Authors: R. Reji, S. K. C., S. Joemo C., R. R., P. Shenoy, A. J. Mathew
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PsA), a chronic, heterogeneous disease, needs long-term management. The concept of ‘Patient acceptable symptom state’ (PASS), evaluated with a dichotomized question on patients’ overall satisfaction with their current state of symptoms, represents the overall health state at which patients consider themselves well. Therapeutic compliance improves when the patient’s perspective of wellness is recognized while modifying treatment. Objectives To identify cut-off points for composite disease activity scores (DAS) and patient reported outcomes (PROs) that can reciprocate the PASS status of a patient with PsA. Methods A cross sectional study was conducted in patients with PsA attending a rheumatology centre in Kerala between March 2020 and Aug 2021. Baseline demographics, clinical characteristics, composite DAS [disease activity index for PsA (DAPSA), clinical (c) DAPSA] and PROs [PsA impact of disease (PsAID), patient pain visual analogue scale (VAS), patient global assessment (PGA), 12-item short-form survey (SF-12)] were compared in patients who responded ‘yes’ and ‘no’ to the ‘PASS’ question. Cut-off values for PASS in composite DAS and PROs were quantified using the Receiver Operator characteristic curve (ROC) curve. Regression models assessed the impact of different variables on the PASS status. Results From a total of 314 patients, 302 who fulfilled the inclusion, exclusion criteria were chosen for analysis. Of them, 171 (56.62%) patients were males. Mean age (S.D) and median disease duration (range) were found to be 50.50 ±11.77 years and 8 (4-14) years respectively. Among the study patients, 215 (70.46%) had acceptable PASS status. Median values for composite scores and patient reported characters in patients who accepted their symptoms and in patients who did not accept their symptoms, are represented in Table 1. Cut-off values for patient pain VAS, Pat GA, DAPSA, cDAPSA and PsAID, with the best tradeoffs between sensitivity and specificity, were found to be 17.5, 25, 10.95, 4.75 and 1.95, respectively (Figure 1A and B). Patients with active psoriatic lesions indicated by higher PASI score, presence of nail involvement, and moderate to high disease activity DAPSA value tended not to attain PASS (OR: 0.793; 95% CI: 0.67-0.93, OR: 0.438; 95% CI: 0.22-0.87, OR:0.168; 95% CI: 0.081-0.349). Figure 1. Table 1. Patient characteristics according to PASS status parameters (median (IQR) PASS+ve PASS –ve p value N=215 N= 87 DAPSA 6.7 (3.54 -11.10) 13 (7.15-18.85) 0.00 cDAPSA 3 (1-7) 11(6-15) 0.00 Dactylitis 0 (0-0) 0 (0-1) 0.00 HAQ 0.25 (0-0.5) 0.5 (0.13-0.88) 0.00 PsAID 1 (0.5-1.9) 2.55 (1.6 -4.3) 0.00 VAS (0-100) 10 (0-20) 40 (10-50) 0.00 Pat GA (0-10) 1 (1-2) 3 (2-5) 0.00 SF 12 PCS (physical component score) 49.67 (42.99-54.31) 40.77 (34.58)-50.12) 0.00 SF12MCS (mental component score) 58.82 (53.96-60.73) 47.16 (39.65-54.83) 0.00 Physician global assessment (1-10) 1 (0-2) 3 (2-4) 0.00 PASI 0.30 (0-0.8) 1 (0.2-4.9) *P&lt;0.05 is considered as significant Conclusion The determined cut-off values for PASS lay in the low disease activity range. A significant number of patients who did not attain PASS, received treatment intensification. Patients with increased PASI, presence of nail dystrophy, and moderate to high disease activity DAPSA value tended to not accept their state. References [1]Fei JZ, Perruccio AV, Ye JY, Gladman DD, Chandran V. The relationship between patient acceptable symptom state and disease activity in patients with psoriatic arthritis. Rheumatology. 2020 Jan 1;59(1):69-76. [2]Lubrano E, Scriffignano S, Azuaga AB, Ramirez J, Cañete JD, Perrotta FM. Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices. RMD open. 2020 Mar 1;6(1):e001170. [3]Maksymowych WP, Richardson R, Mallon C, van der Heijde D, Boonen A. Evaluation and validation of the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Arthritis Care &amp; Research: Official Journal of the American College of Rheumatology. 2007 Feb 15;57(1):133-9. Disclosure of Interests None declared